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Arkansas Gets the Green Light for More Conservative Medicaid Rule

Kevin Lamarque

By Michael Rainey

March 6, 2018

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With the blessing of the Trump administration, Arkansas is taking Medicaid work requirements to a new level.

The administration on Monday granted the state permission to create work requirements for Medicaid recipients. But unlike Indiana and Kentucky, the other states that have been granted similar waivers this year, Arkansas plans to discipline Medicaid recipients who fail to meet the requirements by locking them out of the system for a period of time — the first time a “lockout period” for failure to work, train or volunteer will be deployed in the Medicaid system.

“It’s yet another way the Trump administration is embracing a slew of new regulations and requirements for state Medicaid programs as part of a broader philosophy that poor Americans should have more incentives to find employment and Medicaid should be treated only as a temporary program to give people a leg up,” Paige Winfield Cunningham writes in The Washington Post.

Indiana has also experimented with a lockout system, but it’s triggered by a failure to pay monthly premiums. The effort began in 2015 under the leadership of then-Gov. Mike Pence and consultant Seema Verma, who now runs the Centers for Medicare & Medicaid Services and who represented the Trump administration at the signing of the Arkansas waiver in Little Rock on Monday.

Verma approved Arkansas’ request to impose a work requirement on Medicaid recipients but deferred a decision on the state’s desire to roll back its Medicaid expansion by allowing only those with incomes below the federal poverty level to qualify. Medicaid expansion has added 300,000 adults to the program in the state, and the proposed change would have reduced that number by 60,000.

Arkansas Republican Gov. Asa Hutchinson nevertheless hailed the waiver, saying, “This is not about punishing anyone. It’s about giving people an opportunity to work. It’s to give them the training that they need. It’s to help them to move out of poverty and up the economic ladder.” This is consistent with the general Republican view that social assistance such as Medicaid should be temporary, with success marked by leaving the program.

Hannah Katch of the Center on Budget and Policy Priorities questioned Hutchinson’s assessment, tweeting, “Arkansas' new #Medicaid waiver does not provide any new job search assistance, job training, transportation, child care, or any other services that help people find and hold a job.” Like most liberal critics, Katch sees the effort to impose work requirements on Medicaid recipients as part of a larger effort “to weaken the #Medicaid expansion by making it more difficult for millions of low-income people to get health coverage.”